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BDS4 Radiology > Cysts > Flashcards

Cysts Flashcards

1
Q

What is the definition of a cyst

A

pathological cavity which contains fluid, semifluid or gaseous content and is not created by the accumulation of pus

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2
Q

What are the signs/symptoms of cysts

A

possibly swelling
impeded eruption
often asymptomatic unless infected

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3
Q

What is the first line x-ray for a cyst

A

periapical

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4
Q

When may OPT/occlusal be taken for a cyst

A

When the cyst is too large to be captured fully in a periapical

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5
Q

What supplemental views may be taken in addition to plain film x-ray

A

CBCT/facial radiographs e.g PA mandible/occipitomental

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6
Q

What radiographic features should be noted in a report when reporting on a cyst

A

location
shape
margins
locularity
multiplicity
effect on surrounding anatomy

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7
Q

What may a lack of margins be indicative of

A

infection
lack of corticated margin

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8
Q

What are cysts classified based on

A

structure
origin
pathogenesis

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9
Q

How can cysts be classified by structure

A

epithelial lined vs non epithelial lined

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10
Q

How can cysts be classified by origin

A

odontogenic
non-odontogenic

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11
Q

How can cysts be classified by pathogenesis

A

developmental
inflammatory

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12
Q

What can odontogenic cysts be split into

A

developmental and inflammatory

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13
Q

What are the main developmental odontogenic cysts

A

dentigerous (& eruption cysts)
odontogenic keratocyst
Lateral periodontal cyst

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14
Q

What are the main inflammatory odontogenic cysts

A

radicular cyst (& residual cyst)
inflammatory collateral cysts

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15
Q

What are the two types of inflammatory collateral cysts

A

paradental cyst
buccal bifurcation cyst

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16
Q

What is an example of non-odontogenic developmental cyst

A

nasopalatine duct cyst

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17
Q

What is an example of other non-odontogenic cyst

unknown cause

A

solitary bone cyst
aneurysmal bone cyst

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18
Q

What is unique solitary bone cyst and aneurysmal bone cyst

A

both have no epithelial lining

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19
Q

What is the most common odontogenic cyst

A

radicular

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20
Q

What are some features of odontogenic cysts

A
  • found in tooth bearing areas
  • all epithelial lined
  • most common cause of bony swellings in the jaw
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21
Q

Where can the odontogenic cyst epithelial lining originate from

A

rests of mallasez
rests of serres
reduced enamel epithelium

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22
Q

What is a radicular cyst

A

it is an inflammatory odontogenic cyst

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23
Q

Why are sensibility testing important in diagnosis for radicular cyst

A
  • the tooth must be non vital
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24
Q

How does a radicular cyst form from a non-vital tooth

A

non-vital tooth forms chronic apical infection
chronic apical infection results in periapical granuloma (progression from acute apical abscess/chronic sinus/acute apical periodontitis)
then progresses to radicular cyst

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25
Q

When measuring the size of the radiolucency on the x-ray, what measurement would point to a radicular cyst rather than a PA granuloma

A

> 15mm
indicative of a radicular cyst

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26
Q

What are the radiographic features of a radicular cyst

A

well defined
round/oval
corticated margin is continuous with the lamina dura
larger lesions may displace adjacent structures

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27
Q

What can a long standing radicular cyst result in

A

external root resorption
contain dystrophic calcification

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28
Q

What is dystrophic calcification

can occur in longstanding radicular cysts

A

this is the deposition of calcium salt in degenerated tissues in the absence of systemic mineral imbalance

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29
Q

What type of epithelium is found in the epithelial lining of a radicular cyst

A

non keranizied stratified squamous
variable thickness

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30
Q

What cystic features can be seen on the histopathology for radicular cyst

A
  • epithelial lining (often incomplete)
  • connective tissue capsule
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31
Q

Where do the cells of a radicular cyst originate from

A

rests of mallasez

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32
Q

On a histological level, how does radicular cyst form

A
  • rests of mallasez scells proliferate in the peri-apical granuloma, when this happens the centre of the granuloma is cut off from the blood supply resulting in central necrosis
  • may also form by epithelium surrounding the fluid filled area
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33
Q

What type of growth do we usually see in radicular cysts

A

unicentric balloon type growth

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34
Q

How do radicular cysts continue growth

histology

A

centre of the cyst draws in water from the surrounding areas by osmosis and puts pressure on surrounding bone resulting in resorption

inflammation results in release of inflammatory mediators which increases the cyst size

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35
Q

What are the key histological features that are distinct in radicular cysts

A
  • variable inflammation
  • cholesterol clefts
  • mucous metaplasia
  • hyaline/rushton bodies
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36
Q

What are cholesterol clefts

radicular cysts

A
  • derived from breakdown of RBC as a result of haemorrhage
  • may be few in number or form large mural nodules
  • usually associated with epithelial discontinuities and project into the cyst lumen
  • cholesterol crystals may be found in the cyst fluid
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37
Q

What are hyaline/rushton bodies

radicular cysts

A

found in the epithelial lining
appear as eosinophilic bodies of varying size and shape
of unknown origin

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38
Q

What are the 2 variants of radicular cyst

A
  • residual cyst
  • lateral radicular cyst
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39
Q

What are residual cysts

radicular cysts

A

this is when a residual cyst persists after loss of the tooth/post-RCT (if successful)

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40
Q

What are lateral radicular cysts

radicular cysts

A

*radicular cysts are associated with lateral canals
located at the side of the tooth rather than the apex

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41
Q

What type of cyst is an inflammatory collateral cyst

A

inflammatory odontogenic cyst

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42
Q

What is an inflammatory collateral cyst associated with

A

vital tooth

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43
Q

What are the two main types of inflammatory collateral cysts

A

paradental cyst
buccal bifurcation cyst

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44
Q

What is a paradental cyst

A

typically occurs at the distal aspect of partially erupted third molars

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45
Q

What is a buccal bifurcation cyst

A

typically occurs at the buccal aspect of the mandibular firs tmolar

crown of the tooth will start to tilt buccally

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46
Q

What type of cyst is a dentigerous cyst

A

developmental odontogenic cyst

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47
Q

What type of cyst is a dentigerous cyst

A

developmental odontogenic cysts

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48
Q

What is a dentigerous cyst associated with

A

crown of unerupted tooth and usually impacted tooth

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49
Q

What is the dentigerous cyst derived from

A

cystic change of the dental follicle

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50
Q

What are the radiographic features of a dentigerous cyst

A

corticated margin attached to CEJ of the tooth
may displace involved tooth
tends to be symmetrical initially however larger cysts may expand unilaterally
variable displacement of the bone

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51
Q

What are histological features of dentigerous cysts

A

epithelial lining
islands of odontogenic epithelium in the wall of the dentigerous cyst

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52
Q

What type of epithelium will be seen in dentigerous cyst

A

non keratinized stratified squamous

53
Q

When may a dentigerous cyst resemble a radicular cyst histologically

A

if inflamed

54
Q

How can you differentiate a dentigerous cyst from the dental follicle

A

measure distance from crown to the edge of the follicle

55
Q

What measurements would make us think of a dentigerous cyst when trying to differentiate between it and an enlarged follicle

A

consider a cyst if >4mm
assume a cyst if >10mm
if follicle asymmetrical, consider cyst

56
Q

What is a variant of the dentigerous cyst

A

eruption cyst

57
Q

What makes the eruption cyst different from the dentigerous cyst

A

it is contained within soft tissue, not bone

58
Q

What type of cyst is an odontogenic keratocyst

A

developmental odontogenic cyst

59
Q

Is the keratocyst associated with the teeth

A

no

60
Q

What type of growth is seen in odontogenic keratocyst

A

aggressive

61
Q

What is the most ‘dangerous’ feature of the odontogenic keratocyst

A

has high recurrence

62
Q

What are the radiographic features of the odontogenic keratocyst

A

often have scalloped margins
1/4 multilocular
often causes displacement of adjacent teeth
characteristic expansion

63
Q

What is the characteristic expansion of the odontogenic keratocyst

A

enlarges significantly in the medullary bone before displacing cortical bone aka expands a lot in the emsial distal direction before spreading buccal/lingually

64
Q

What type of biopsy is taken for an odontogenic keratocyst

A

aspirational biopsy

65
Q

What will be diagnostic characteristic features are seen in the OK aspirational biopsy

A

greasy fluid
keratotic squames
low soluble protein content compared to other cysts (<4g% is diagnostic)

66
Q

What histological features will be seen in a keratocyst

A

palisades
parakeratosis
cell nests
daughter cysts

67
Q

OK histology

What are palisades

A

refer to the neat stacking of parallel rows of elongated nuclei

68
Q

What is parakeratosis

A
  • incomplete maturation of epidermal keratinocytes resulting in abnormal retention of nuclei in the stratum corneum
69
Q

What is orthokeratosis

A

thickening of the keratin layer with preserved keratinocyte maturation

70
Q

When may the keratin layer not be present in an odontogenic keratocyst

A

if it is inflamed

71
Q

Seen in the OK histology

What are cell nests

A

epithelium seperating from the walls resulting in islands of epithelium

72
Q

What can cell nests turn into

A

daughter cysts
responsible for high recurrence

73
Q

What syndrome presents with multiple odontogenic keratocysts

A

basal cell naevus syndrome

74
Q

What other features do those with basal cell naevus syndrome present with

A

multiple basal cell carcinomas on the skin
palmer and plantar pitting on the hands and feet
calcification of intracranial dura mater
histologically the cysts dont differ to the non syndromic form

75
Q

What age is odontogenic keratocyst most common in

A

teenagers/YA

76
Q

What gender is odontogenic keratocyst most common in

A

males

77
Q

Which jaw is odontogenic keratocyst most common in

A

mandible

78
Q

Are odontogenic keratocysts more common anterior or posterior

A

posterior

79
Q

What age group are dentigerous cysts most common in

A

teenagers/YA

80
Q

What gender are dentigerous cysts most common in

A

males

81
Q

What jaw is dentigerous cysts most common in

A

mandible

82
Q

What age group is radicular cysts most common in

A

30s to 40s

83
Q

Which gender is radicular cyst most common in

A

equal split

84
Q

What type of cyst is nasopalatine duct cyst

A

developmental non odontogenic keratocyst

85
Q

Where does the nasopalatine duct cyst arise from

A

nasopalatine duct epithelial remnants

86
Q

Where is the nasopalatine duct

A

it runs through the nasopalatine canal which starts at the base of the anterior nasal cavity and goes through the maxilla, opening up at the incisive fossa

87
Q

Where does the nasopalatine duct cyst occur

A

always anterior maxilla

88
Q

What age group is nasopalatine duct cyst most ommon in

A

30s to 50s

89
Q

Which gender is nasopalatine duct cyst most common in

A

males

90
Q

Which jaw is the nasopalatine duct cyst most common in

A

maxilla
anterior

91
Q

What is the presentation of nasopalatine duct cyst

A
  • often asymptomatic
  • patient may C/O salty discharge
  • larger cysts may displace teeth and cause swelling in the palate
  • always involves the midline but not always symmetrical
92
Q

What are the radiographic features of nasopalatine duct cyst

A
  • corticated radiolucency between/over roots of central incisors
  • generally unilocular (rare to be multilocular)
  • may appear as heart shaped due to superimposition of anterior nasal spine - characteristic
  • can be asymmetrical
93
Q

What is the ideal view for nasopalatine duct cyst

A

PA/maxillary occlusal

94
Q

When is CBCT indicated for nasopalatine duct cyst

A
  • if better visualisation of cyst needed for surgical planning
95
Q

What are the histological features of nasopalatine duct cysts

A
  • variable epithelial lining
  • may be made up of non-keratinized stratified squamous epithelium & modified respiratory epithelium
96
Q

What type of epithelium is respiratory epithelium

A

ciliated pseudostratified columnar

97
Q

How does the incisive fossa appear on a radiograph (doesnt always appear)

A
  • oval shaped radiolucency
  • typically not corticated
98
Q

How can we decide if a radiolucency is a nasopalatine cyst or incisive fossa

A

consider the transverse diameter (only if the px is asymptomatic, otherwise lean towards cyst)
* <6mm = assume incisive fossa
* 6-10mm = consider monitoring (x-ray in 3-6 months)
* >10mm = suspect cyst

99
Q

What age group is solitary bone cyst most common in

A

teenagers

100
Q

What jaw are solitary bone cysts most common in

A

mandible

101
Q

What gender are solitary bone cysts most common in

A

males

102
Q

What gender are solitary bone cysts most common in

A

males

103
Q

What is a solitary bone cyst

A

non odontogenic cyst
no epithelial lining

104
Q

What is a solitary bone cyst aka

A

simple/traumatic/haemorrhagic bone cyst

105
Q

What can a solitary bone cyst occur in association with

A

other bony pathology e.g fibro-osseous lesions

106
Q

What is the clinical presentation for solitary bone cyst

A

usually asymptomatic
rarely any pain or swelling

107
Q

What are the radiological features of solitary bone cyst

A
  • majority in the premolar region of the mandible
  • can occur in non tooth bearing areas
  • variable definition and cortication
  • may have scalloped margins giving a pseudolocular appearance
  • may project up between roots of adjacent teeth
108
Q

What is a stafne cavity

A

not a cyst
often mistaken as one
it is depression of the bone

109
Q

Where do stafne cavities usually occur

A

mandible
usually lingual
usually in angle or body

110
Q

What do stafne cavities contain

A

salivary/fatty tissue

111
Q

What is teh presentation of stafne cavity

A

asymptomatic
rarely displaces adjacent structures

112
Q

What is the radiographic features of stafne cavity

A

well defined
often corticated margins

113
Q

What is the first line biopsy for a cyst

A

aspirational

114
Q

What is an aspiration biopsy

A

drainage of contents

115
Q

What can be captured in an aspiration biopsy

A
  • air
  • blood
  • pus
  • cyst fluid
116
Q

How can cyst fluid aid diagnosis

A

clear/straw coloured fluid = inflammatory/developmental cyst
thick white fluid = keratocyst

117
Q

What is the purpose of the incisional biopsy

A

it is partial removal
aims to obtain lining sample

118
Q

What is the method for incisional biopsy

A
  • LA
  • select area where lesion appears most superficial
  • raise mucoperiosteal flap
  • remove bone as required
  • incise and remove section of lining
  • may be combined with marsupialisation
119
Q

What is the decision to take a biopsy dependant on

A
  • size
  • site
  • radiographic characterisation
120
Q

What is a excisional biopsy

A

full removal
following enucleation most likely

121
Q

What are the 2 tx options for cyst

A

enucleation
marsupialisation

122
Q

What is enucleation

A
  • all of the cystic lesion removed
  • usually under GA
123
Q

What are the advantages of enucleation

A
  • preferred option
  • whole lining cna be examined pathologically
  • primary closure achieved = better healing
  • less aftercare required
124
Q

What are the disadvantages of enucleation

A
  • risk of mandibular fracture with very large cysts, marsupialisation preferred
  • dentigerous cyst where loss of tooth is undesirable
  • old age/ill health, GA often reqiured for enucleation
  • blood clot filled cavity forms after removal and can get infected
  • damage to adjacent structures e.g IAN
125
Q

What is the method for enucleation

A
  • raise mucoperiosteal flap
  • expose bone
  • remove cyst
  • close mucoperiosteal flap
126
Q

What are the indications for marsupialisation

A
  • if enucleation would damage adjacent structures
  • difficult to access area
  • may allow for eruption of teeth that are impacted by dentigerous cyst
  • elderly/medically compromised patient unable to withstand extensive surgery
  • very large cysts which would risk jaw fracture if enucleation performed
  • can combine with enucleation later on when cyst shrinks
127
Q

What are contraindications to marsupialisation

A
  • opening may close and cyst may reform - obturator required to keep marsupialsation windows open
  • complete lining ont available for histology
  • hard to keep clean, aftercare required
128
Q

What are the advantages of marsupialisation

A
  • simple to perform
  • under LA
  • may spare vital structures
129
Q

What factors does tx depend on

A
  • nature of lesion
  • age of px
  • degree of involvement
  • radiographic characterisation
  • histopathology

BDS4 Radiology (8 decks)

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